Cognitive Ergonomics Laboratory (LECIT), Department of Work Psychology, University of Liège, Sart-Tilman B31, 4000, Liege, Belgium.
Emergency Department, University Hospital Centre of Liège, Liege, Belgium.
Intern Emerg Med. 2018 Dec;13(8):1273-1281. doi: 10.1007/s11739-018-1873-3. Epub 2018 May 18.
Fatigue has major implications on both patient safety and healthcare practitioner's well-being. Traditionally, two approaches can be used to reduce fatigue-related risk: reducing the likelihood of a fatigued operator working (i.e. fatigue reduction), or reducing the likelihood that a fatigued operator will make an error (i.e. fatigue proofing). Recent progress mainly focussed on fatigue reduction strategies such as reducing work hours. Yet it has to be recognized that such approach has not wholly overcome the experience of fatigue. Our purpose is to investigate individual proofing and reduction strategies used by emergency physicians to manage fatigue-related risk. 25 emergency physicians were recruited for the study. Four focus groups were formed which consisted of an average of six individuals. Qualitative data were collected using a semi-structured discussion guide unfolding in two parts. First, the participants were asked to describe how on-the-job fatigue affected their efficiency at work. A mind map was progressively drawn based upon the participants' perceived effects of fatigue. Second, participants were asked to describe any strategies they personally used to cope with these effects. We used inductive qualitative content analysis to reveal content themes for both fatigue effects and strategies. Emergency physicians reported 28 fatigue effects, 12 reduction strategies and 21 proofing strategies. Content analysis yielded a further classification of proofing strategies into self-regulation, task re-allocation and error monitoring strategies. There is significant potential for the development of more formal processes based on physicians' informal strategies.
疲劳对患者安全和医疗保健从业者的健康都有重大影响。传统上，可以使用两种方法来降低与疲劳相关的风险：减少疲劳操作人员工作的可能性（即疲劳减少），或减少疲劳操作人员犯错的可能性（即疲劳防护）。最近的进展主要集中在疲劳减少策略上，例如减少工作时间。然而，必须认识到，这种方法并没有完全克服疲劳的体验。我们的目的是调查急诊医生用于管理与疲劳相关风险的个体防护和减少策略。研究招募了 25 名急诊医生。组成了四个焦点小组，每组平均有六个人。使用半结构化讨论指南收集定性数据，该指南分为两部分展开。首先，要求参与者描述在职疲劳如何影响他们的工作效率。根据参与者对疲劳影响的感知，逐步绘制思维导图。其次，要求参与者描述他们个人用来应对这些影响的任何策略。我们使用归纳定性内容分析来揭示疲劳影响和策略的内容主题。急诊医生报告了 28 种疲劳影响、12 种减少策略和 21 种防护策略。内容分析进一步将防护策略分为自我调节、任务重新分配和错误监控策略。基于医生的非正式策略，开发更正式流程的潜力很大。
